Liposuction 101

Liposuction Techniques

Doctors use several different types of liposuction procedures. These include:

Tumescent technique

Developed by plastic surgeons in the 1980s, this has become the most popular liposuction method. It is also considered safer than other methods because it limits blood loss and does not usually require intravenous fluid replacement afterwards.

In this procedure, the doctor injects a large volume of anesthetic-containing fluid (as much as five times the fluid and tissue that is removed) into the areas containing fatty deposits. The fluid contains a local anesthetic (lidocaine), a drug that constricts blood vessels to reduce blood loss (epinephrine) and a salt solution to allow for easier fat removal. The fluid causes the fatty tissue to swell up and harden (become tumescent), making it easier to remove with the cannula. Because the fluid contains quite a bit of lidocaine, this procedure is usually performed under a local anesthetic. Although it tends to take longer than other techniques -- as many as four to five hours -- the tumescent technique has the advantages of reducing postoperative swelling, bruising and pain.Courtesy University of Nebraska Medical Center

Super-wet technique

This technique is similar to the tumescent technique, with the exception that it uses less fluid (about the same amount as the amount of fluid and fat tissue removed). Although a small amount of lidocaine is sometimes added to the fluid, this technique often requires general or IV-epidural anesthesia. The procedure takes between one to two hours to perform.

­Ultrasound-assisted liposuction (UAL)

T­his re­latively new technique uses a special cannula that vibrates very rapidly and gives off ultrasound energy. As the cannula passes through the fat cells, that energy liquefies the fat cells, which are then su­ctioned out. The ultrasound can be administered either above the skin (with a special emitter) or below the surface of the skin (with an ultrasound cannula).

There are two types of ultrasound cannulas:

a solid probe

a hollow-core probe

The solid probe creates a collection of emulsified fat and tumescent solution beneath the skin, which is then removed with a standard, suction-type cannula. The hollow-core probe both emulsifies fat and removes it, but the doctor must usually go back in with a standard cannula to remove the emulsified fat that the probe leaves behind (Sattler, 2005).

The UAL takes longer to perform than other types of liposuction, but it is more precise and tends to be more effective, especially at removing fat from fibrous areas of the body, such as the back and male breasts. The drawback is that it generates a lot of heat. If the cannula is not removed quickly enough, it can cause a burn. What's more, doctors still don't know the long-term effects of internal ultrasound exposure.

Power liposuctionDoctors now have at their disposal a motorized cannula, which moves back and forth at very rapid speeds over a distance of 3 to 5 millimeters. It can remove about 40 percent more fat per minute than manual liposuction, meaning the procedure takes less time to perform, and it provides smoother results, say doctors (Wagner, 2001). ­

The History of Liposuction

In 1975, Italian researchers Georgio and Arpad Fischer first came up with the idea of removing fat through hollow tubes attached to a suction device. But their "dry" liposuction technique had many risks, most notably severe blood loss and postoperative complications such as skin dents. A French surgeon, Yves-Gerard Illouz, later devised the safer "wet" technique, in which he injected a salt solution into the surgical area to reduce blood loss and ease removal of fat tissue. In 1987, a California dermatologist, Jeffrey Klein, came up with the tumescent technique, adding the anesthetic lidocaine into the injected solution. This remains the most popular liposuction technique used today.

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